Shots - Health News

3:25 pm

Tue April 8, 2014

Wave Of Newly Insured Patients Strains Oregon Health Plan

Cheryl Stumph goes over paperwork with a medical worker. She finally has health insurance to take care of her family's medical needs.

Kristian Foden-Vencil for NPR

Millions of Americans who didn't have health insurance last year now do because of the Affordable Care Act.

In Lane County, Oregon, Trillium Community Health Plan is struggling to deal with a huge influx of new patients looking for health care. CEO Terry Coplin says the company figured 26,000 people would sign up in the first few years. Instead, about that many signed up right off the bat.

"We weren't expecting to get such a large assignment of patients in the first two months," says Coplin. "These patients who are coming onto the program — many have not seen a physician for years. We're dealing with not just a large number of patients, but also what appears to be a much sicker population of patients."

Cheryl Stumph is one of them. She and her husband, Mike, run Green Streak Automotive, an all-service garage in Veneta, Ore.

"Cars and trucks and tractors and generators and lawn mowers and boats and motor homes, and I think the only thing I haven't done is an airplane, so far," she says.

Last November, Stumph's 27-year-old son had a stroke and died at the wheel of his tow truck. The stroke stemmed from a genetic problem, so Stumph spent the winter worrying about her six other kids.

Genetic testing is expensive, and she didn't have health insurance. But now she and her family get Medicaid through Trillium Health.

"That was really relieving," Stumph says. "You know, because we can check on the other kids and maybe not lose them. Oh, my God, we're 50 and aren't there things we're supposed to do at this age of our lives? And, you know, we're doing it, and it's great. It just gives you hope."

She's thrilled to be able to get a mammogram and treatment for a stubborn infection. The kids can get genetic testing. She says her husband has a chronic medical problem that needs attention, too.

Stories like Stumph's are being repeated across Oregon. Trillium Health is overwhelmed.

Trillium's Coplin says the health plan has come up with a four-part plan to deal with this unexpected influx.

First, it will pay bonuses to doctors who accept new patients covered by Trillium.

Second, Trillium is giving Lane County $900,000 to open a new clinic in an existing building. "They have proposed ways that they can get this clinic up and running by mid-year," says Coplin.

Third, Trillium is hiring a consultant to see if existing clinics can increase efficiency, for example, by changing who fills out forms. "Having physicians do clerical work is really a waste of valuable resources," Coplin says.

And finally, Trillium is offering $500,000 to any clinic or group of physicians willing to expand their practice to take on another 5,000 adult patients.

Meanwhile, Trillium is making some short-term fixes to help new enrollees find a doctor in the area.

Coplin says if people suffer serious accidents, they can go to the emergency room. If the injuries are less serious, they can go to urgent care.

But someone suffering a minor complaint can fall through the cracks.

Lane County Public Health Officer Dr. Patrick Luedtke thinks Trillium's plans will probably work, but he's anxious about those cracks.

"We have a shrinking pool of providers, and we have a growing need, in an aging population, for health care," he said. "So we need to get creative, and that's what we're doing."

Stumph is pleased to be getting treatment, but there have been hitches. "It took a month, I think, to get the first appointment for my husband," she says.

They've been to several appointments and the doctor told Cheryl she'd have to give up smoking, get a little more exercise and follow all the usual doctor recommendations. She says she's working on it.

This story is part of a partnership with NPR, Oregon Public Broadcasting andKaiser Health News.

And I'm Audie Cornish. Millions of Americans who didn't have health insurance last year have it now as a result of the Affordable Care Act. That means a lot of people are looking for new primary care providers. Insurers are struggling with the influx and are also learning that these new patients may be eager to use their plans because they haven't had health insurance for a long time.

Kristian Foden-Vencil of Oregon Public Broadcasting tells us how one organization in the city of Eugene is dealing with those challenges.

KRISTIAN FODEN-VENCIL, BYLINE: Cheryl Stumph and her husband, Mike, run Green Streak Automotive, an all-service garage in the small Willamette Valley town of Veneta.

CHERYL STUMPH: Cars and trucks and tractors and generators and lawn mowers and boats and motor homes, and I think the only thing I haven't done is, like, an airplane, so far.

FODEN-VENCIL: In November, Stumph's 27-year-old son had a stroke and died at the wheel of his tow truck. The stroke stemmed from a genetic problem so Stumph spent the winter worrying about her six other kids, aged between nine and 33. Genetic testing is expensive, and she didn't have health insurance. But then, she was referred to Oregon's health insurance exchange and now gets Medicaid from the local coordinated care organization, Trillium Health.

STUMPH: That was really, really relieving. You know, because we can check on the other kids and maybe not lose them and oh, my God, we're 50 and aren't there things we're supposed to do at this age of our lives? And we're doing it, and it's great. It just gives you a hope.

FODEN-VENCIL: She was thrilled to be able to get a mammogram and treatment for a long term infection. The kids can get genetic testing and her husband also has a chronic medical problem that needs attention. Stories like Stumph's are being repeated across the nation. In Lane County, for example, 26,000 people enrolled in Medicaid in the first couple of months. That was as many as the country expected in the first two years. Terry Coplin, the head of Trillium Health, is concerned.

TERRY COPLIN: We weren't expecting to get such a large assignment of patients in the first two months. Many have not seen a physician for years. We're dealing with not just a large number of patients, but also what appears to be a much sicker population of patients.

FODEN-VENCIL: In fact, in Lane County alone, about 9,000 adults who recently signed up for insurance don't have a primary care provider yet. So what's Trillium doing about it? Terry Coplin says they've come up with a four-part plan, first to pay bonuses to doctors who accept new members. Second, Trillium is granting Lane County $900,000 to open a new clinic.

COPLIN: They have proposed ways that they can get this clinic up and running by mid-year.

FODEN-VENCIL: Third, Trillium is hiring a consultant to see if existing clinics can be more efficient, for example, by changing who fills out forms.

COPLIN: Having physicians do clerical work is really a waste of valuable resources.

FODEN-VENCIL: And finally, Trillium is offering half a million dollars to any clinic or group of physicians willing to expand their practice to take on another 5,000 adults. Meanwhile, Trillium is asking patients who suffer a serious accident to go to the ER or if the injury is less serious, to urgent care. Lane County Public Health Officer Dr. Patrick Luedtke thinks Trillium's plans will likely work, but he's anxious about people not having ready access to a primary care provider.

PATRICK LUEDTKE: I see it more as a challenge. At what point does the challenge become a problem? I don't know that answer, but we have a shrinking pool of providers, and we have a growing need, in an aging population, for health care. So we need to get creative, and that's what we're doing.

FODEN-VENCIL: Back at a doctor's office, garage owner Cheryl Stumph goes over some paperwork. She is pleased to be getting treatment, but it hasn't all been a bed of roses.

STUMPH: It took a month, I think, to get the first appointment for my husband.

FODEN-VENCIL: They've been to several appointments and the doctor told Cheryl she'd have to give up smoking, get a little more exercise and follow all the usual recommendations. For NPR News, I'm Kristian Foden-Vencil in Portland.

BLOCK: This story is comes to us from a collaboration with NPR, Oregon Public Broadcasting and Kaiser Health News. Transcript provided by NPR, Copyright NPR.